Healthcare reform in South Africa

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Health care in South Africa varies from the most basic primary health care, offered free by the state, to highly specialized health services available in the public and private sector.

 

However, the public sector is stretched and under-resourced in places. The public health sector is under pressure to deliver services to about 80% of the population.

The private sector, on the other hand, is run largely on commercial lines and caters to middle- and high-income earners who tend to be members of medical schemes. It also attracts most of the country's health professionals.

Institutions in the public sector have suffered poor management, underfunding and deteriorating infrastructure. While access has improved, the quality of health care has fallen.

However, the South African government is responding with a far-reaching reform plan to restructure the South African health care system;

  • Fast-tracking the implementation of a National Health Insurance scheme
  • Strengthening the fight against HIV and TB, as well as injury and violence
  • Improving human-resource management at state hospitals and strengthening co- ordination between the public and private health sector.
  • Regulating costs to make health care affordable to all
  • High levels of poverty and unemployment mean health care remains largely the burden of the state.
  • Public health consumes around 11% of the government's total budget, which is mostly spent by the nine provinces. How these resources are allocated, and the standard of health care delivered, varies from province to province.
  • South Africa has more than 110 registered medical schemes, with around 3 - 4-million principal members and 7 - 8-million beneficiaries.
  • Since 1994, more than 1 600 clinics have been built or upgraded and today there are more than 4 200 public health facilities. Free health care for children under six and for pregnant or breastfeeding mothers was introduced in the mid-1990s.
  • The vast majority of GPs work in the private sector, there is just one practicing doctor for every 4 219 people.
  • In response, the Department of Health has introduced health associates, health-care providers to work in underserved rural areas.
  • Newly graduating doctors and pharmacists complete a year of compulsory community service in understaffed hospitals and clinics.
  • The government has launched the National Strategic Plan for HIV/AIDS and TB for 2012 – 2016. The plan seeks to address the social drivers of HIV/Aids, STD and TB care, prevention and support; to prevent new infections; to sustain health and wellness and to protect human rights.
  • Immunization is a significant barrier against disease and death, and the rates of children receiving their primary vaccines have steadily been increasing under immunization programs. These aim to protect children against vaccine-preventable diseases, such as measles, TB, cholera and pertussis.

The Department of Health is focused on implementing an improved health system, which focuses on public health, as well as improving the functionality and management of the system through budget and expenditure monitoring.

The National Health Institution is intended to bring about reform that will improve services and health care delivery. It will promote equity and efficiency to ensure that all South Africans have access to affordable, quality health care services regardless of their employment status and ability to make a contribution to the NHI Fund.

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